The recent placement of Tri-City Healthcare CEO Larry Anderson on paid administrative leave for an as yet undisclosed “personnel matter” signals a remarkable change from the days not long ago when it was Anderson, acting as puppet-master, used willing board allies to do the banishing for him.

During the darkest days of his tenure, Anderson was able to marginalize then-board members Randy Horton and Kathleen Sterling through a combination of lawsuits and board actions that served to characterize the two whistle-blowing officials as — at best — lunatics, and — at worst — criminals. While Horton and Sterling may not have helped their cause by some of their actions, the truth of the matter is what they were most guilty of was not being willing to go along to get along.

The circus-like atmosphere within Tri-City’s leadership structure has become the stuff of legend and, in a region with no shortage of contentious and, arguably, dysfunctional government bodies, they stand apart. Things got so bad the San Diego County Grand Jury even felt compelled to weigh in two years ago, suggesting a wholesale change was in order.

Now through an election and a series of recent events that change has come. And with that change, it seems, comes a new level of accountability for the CEO.

The additions of Ramona Finnila, Julie Nygaard, and now Paul V. L. Campo to the district’s board of directors breaks up a majority that had functioned as enablers for a litany of questionable actions by Anderson, including engaging in lawsuits that served to do little but enrich the district’s law firm, and entering into a contract to build a medical office building with onerous terms.

The financial performance of the district has been a mixed bag and, while improved, has not met targets or promises Anderson has made to the Board or the community. Anderson’s fiscal shell game may not be the reason he’s on the hot seat now but watch the linguistic legerdemain that ensues whenever a new financial report comes out with disappointing news is entertaining.

Meanwhile, by many accounts, the care given by healthcare workers at Tri-City Medical Center is among the best in the region, approaching their profession with the dedication and pride anyone would want. They do this while lamenting the public relations beating their so-called leaders have subjected the image of their district to for over a decade.

As I write this, it’s too early to know whether Anderson is on his way out as CEO. If it is the end of his tenure, rather than looking for a new CEO, it may be time to look at the district as a whole.

With the myriad changes roiling the healthcare industry, now may be the best time to ask and answer the question: Is a single hospital healthcare district viable in today’s healthcare environment? Maybe it’s time for Palomar Health and Tri-City to start a conversation — again.

Kirk W. Effinger was born in San Diego and raised in Southern California. He and his family have been residents of San Marcos for the past 30 years. His opinion columns have appeared regularly in the North County Times and, later, the San Diego Union-Tribune since 1995. He can be reached at kirkinsanmarcos@att.net or follow him on Twitter at @kirkeffinger